Provider Demographics
NPI:1649581620
Name:KELLEY, CLAIRE JULIA (FNP)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:JULIA
Last Name:KELLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 N 7TH ST
Mailing Address - Street 2:SUITE 375
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2707
Mailing Address - Country:US
Mailing Address - Phone:602-307-0070
Mailing Address - Fax:602-307-0080
Practice Address - Street 1:1331 N 7TH ST
Practice Address - Street 2:SUITE 375
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2707
Practice Address - Country:US
Practice Address - Phone:602-307-0070
Practice Address - Fax:602-307-0080
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN 133632363LF0000X
AZAP3704363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ539775Medicaid
AZ539775Medicaid